First Case of Deep Hypothermic Circulatory Arrest in Senegal (West Africa): Congenital Heart Disease Management

Abdel-Kémal Bori Bata

doi:10.11648/j.ijcts.20180405.11

Abstract

Background: Deep hypothermic circulatory arrest (DHCA) is an extracorporeal circulation (EC) technique used to correct complex congenital cardiac lesions. This technique ensures excellent operating conditions while reducing consequences of organ ischaemia, particularly of the brain. Griepp was the first to demonstrate in 1975, that the technique offered a practical and safe approach for aortic arch surgery. Case Report: Authors aim at reporting the practical conduct of DHCA’s first case performed in Dakar (Senegal) on a 30- month-old patient diagnosed with supracardiac total anomalous pulmonary venous connection (TAPVC). The cooling had started 8 minutes after CPB was initiated and continued while the surgeon dissected the pulmonary veins, the collector, and the innominate vein. After the establishment and the starting up of the cardiopulmonary bypass, circulatory arrest was performed at 18°C with 32 minutes of arrest time. The anastomosis between collector and posterior of the left atrium was achieved during a circulatory arrest. In the immediate postoperative period, patient showed episodes of hypothermia and biological bleeding. During her hospitalization, the patient developed a lung infection and PAH crisis, kept under control with antibiotic, diuretics, oxygen and sildenafil. Neurological, kidney, metabolic or ionic complications have not been observed. The patient stayed at the hospital for 32 days. Conclusion: DHCA technique is a common practice in developed countries. However, it can also be carried out in West Africa as evidenced by this clinical case. This prowess testifies a strengthening of our skills in EC technique; and also, the possibility of correcting complex congenital cardiac lesions.

Highlights

Deep hypothermic circulatory arrest (DHCA) is a technique used to repair complex congenital cardiac lesions that requires aortic arch or pulmonary vein repair
DHCA is an unusual cardiopulmonary bypass (CPB) technique in West Africa where cardiac surgery is virtually non-existent in most countries
This report aims at describing a practical conduct of the first case of DHCA that has been performed for surgical correction of total anomalous pulmonary venous connection (TAPVC) at the Pediatric Cardiac Surgery Center of the University Hospital of Fann in Senegal. [1,2,3,4]

Summary

Introduction

Deep hypothermic circulatory arrest (DHCA) is a technique used to repair complex congenital cardiac lesions that requires aortic arch or pulmonary vein repair. This technique ensures excellent operating conditions while reducing consequences of organ ischaemia, of the brain. Since the introduction of DHCA in early 1960s, Griepp was the first to demonstrate in 1975, that the technique offered a practical and safe approach for aortic arch surgery. During CPB, 500 ml of ringer, 250 ml of FFP, 25 ml of Mannitol (20%) were perfused. During CPB, 500 ml of ringer, 250 ml of FFP, 25 ml of Mannitol (20%) were perfused. (Figure 1)

Case Report

Discussion

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Conclusions